IWCC's New Fee Schedule Region Update

Discussions pertaining to the new fee schedule regions took up the vast majority of the IWCC Workers’ Compensation Medical Fee Advisory Board’s meeting on Tuesday.  Here’s an overview of that debate.

The Board passed a motion clarifying that the new regions and reprice amounts will apply to bills with dates of service of 1/1/2012 and later.  Any dates of service before 1/1/2012 will still apply the previous geozip-based fee schedules.

For all of the options presented to the Board on Tuesday:

·         Calculations are based on the code’s 9/1/2011 geozip reprice amount.

·         If any part of a geozip is included in the region, that geozip’s population, reprice amounts, etc. is included in the average/weighted average for the new region.

o    For example:

§  Geozip 600 is located in Cook, Lake, and McHenry Counties. 

§  For non-hospital bills, all of geozip 600’s reprice amounts, population, etc. is included in the calculations and weighting methodologies for

·         Region 1–Cook County

·         Region 2–DuPage, Kane, Lake, & Will Counties

·         Region 4–all other counties (McHenry County is included in this region)

§  For hospital bills, all of geozip 600’s reprice amounts, population, etc. is included in

·         Region 1–Cook, DuPage, Will, Kane, McHenry, DeKalb, Kendall, and Grundy Counties

·         Region 10-Lake County

Calculation Options Presented to the Board

Non-Hospital Regions

1.    Straight average of all the included geozips’ reprice amounts for each code.

2.    Weighted average, by county population, of all the included geozips’ reprice amounts for each code.

3.    Weighted average, by geozip population, of all the included geozips’ reprice amounts for each code.

Hospital Regions

1.    Straight average of all the included geozips’ reprice amounts for each code.

2.    Weighted average, by county population, of all the included geozips’ reprice amounts for each code.

3.    Weighted average, by geozip population, of all the included geozips’ reprice amounts for each code.

4.    Weighted average, by discharges, of all the included geozips’ reprice amounts for each code.

5.    Weighted average, by days, of all the included geozips’ reprice amounts for each code.

After debating the merits of the various calculation methodologies, the Board narrowed them down to two potential options:

1.    Straight average of all the included geozips’ reprice amounts for each code.

2.    Weighted average, by geozip population, of all the included geozips’ reprice amounts for each code.

In the next two weeks, Glen Boyle and his team will run an extended analysis for both the Hospital and Non-Hospital regions.  He will send out the results to the Board members, and the meeting attendees who supplied their email addresses, before the next Board meeting on September 13.  The Board plans on making a final decision on the calculation methodology at that meeting.